Hypercalcemia of malignancy Max recommended dose: 4 mg (diluted in 100 mL NaCl 0.9% or dextrose 5%) as single dose IV infusion over not <15 min. Retreatment w/ 4 mg may be considered if necessary after minimum of 7 days has elapsed. Multiple myeloma & metastatic bone lesions of solid tumorsPatients w/ CrCl >60 mL/min 4 mg (diluted in 100 mL NaCl 0.9% or dextrose 5%) infused over not <15 min every 3-4 wk, 50-60 mL/min 3.5 mg, 40-49 mL/min 3.3 mg, 30-39 mL/min 3 mg.
Not recommended in patients w/ bone metastases w/ severe renal impairment. Discontinue use if severe symptoms of musculoskeletal pain develop. Osteonecrosis of the jaw. Bronchoconstriction in aspirin-sensitive patients. Adequately rehydrate patients w/ hypercalcemia of malignancy prior to administration. Avoid overhydration in patient w/ cardiac failure. Monitor serum levels of Ca, phosphate, Mg & creatinine following initiation of therapy. Concomitant use w/ loop diuretics & other nephrotoxic drugs. Renal & hepatic impairment. Not to be used during pregnancy. Not to be administered to a nursing woman. Not for use in childn. Elderly.
May have additive effect in lowering serum Ca level w/ aminoglycosides (prolonged use). Increased risk of hypocalcemia w/ loop diuretics. Nephrotoxic drugs. May increase risk of renal dysfunction in multiple myeloma patients w/ thalidomide.